The Coronavirus and Air Transport

The World Health Organization (WHO) has yet to label the crisis as a public health emergency and is watching the spread, seemingly hoping for containment and management of the spread.

by Dr. Ruwantissa Abeyratne

Writing from Montreal

Over last week, the Coronavirus (a cousin of the SARS virus (an acronym for Severe Acute Respiratory Syndrome which was first discovered in Asia in February 2003) spread quickly, and as at Saturday 25th January, it had killed 41 people and infected 14,000 people in China. The virus had spread across borders to Thailand, Malaysia, Australia, France and the United States. Festivities in connection with the Chinese New Year have been canceled in Beijing, Hong Kong and other major cities to control the spread of the virus. China is building two new hospitals in the province over the next few weeks (if not days) that would accommodate thousands of affected cases that are expected to be reported over the next few days.

Dr. Kathy Lofy, a health official in Washington, states that the Coronavirus: "primarily spreads through close contact with another individual, in particular through coughing and sneezing on somebody else who is within a range of about 3 to 6 feet from that person." This scenario is consistent with what goes on inside an airplane where passengers are in close proximity to each other.

The World Health Organization (WHO) has yet to label the crisis as a public health emergency and is watching the spread, seemingly hoping for containment and management of the spread.

There is a regulatory system which is applicable in the aviation context that was successfully implemented both by the International Civil Aviation Organization (ICAO) and WHO – the two United Nations Agencies charged with the role of global watchdogs in their respective areas of specialized work during the SARS crisis. It must be noted at the outset that the responsibility starts with the affected State itself. Article 14 of the Chicago Convention of 1944 obligates each contracting State (to the Convention) to take effective measures to prevent the spread by means of air navigation of cholera, typhus (epidemic), smallpox, yellow fever, plague, and such other communicable diseases ( the phrase “such other communicable diseases” is operative here) as the contracting States must from time to time decide to designate, and to that end contracting States must keep in close consultation with the agencies concerned with international regulations relating to sanitary measures applicable to aircraft. Such consultation must be without prejudice to the application of any existing international convention on this subject to which the contracting States may be parties.

At this stage, the key drivers of response that the aviation community must concentrate on are governance and anticipatory or predictive intelligence. That is to say, the major role in combating a possible Coronavirus public health emergency should be played by both governments and international Organizations, by preventing and mitigating a pandemic. Such an effort would naturally require cooperation and coordination, along with a concerted effort on the part of the international community to coordinate assistance with a view to ensuring support for all major areas while obviating duplication of efforts. A key support area would lie in financing, particularly poor countries and the provision of critical commodities to them. Needless to say, air transport would be playing a key role in this endeavour, which is all the more reason to have a contingency plan for the sustenance of global air transport in a crisis situation.

In this context, of some use would be a journey back in history to take be a look at the SARS crisis of seventeen years ago. On 18 November 2005, temperature screening of people arriving at Hong Kong at Lowu and Lok Ma Chau were activated using infra-red thermo imagery techniques. This measure amply demonstrated that, from an air transport perspective, technology is available to combat an outbreak of contagion around the world as States will find it increasingly easier to implement measures once used during the SARS crisis, particularly as both ICAO and IATA (The International Air Transport Association) carried out an exhaustive programme of action when the SARS crisis erupted. Both Organizations worked closely with WHO during that crisis and continued their efforts in the context of the new threat to public health. IATA’s Medical Advisory Group had worked with WHO to develop guidelines for check-in agents, cabin crew, cleaning staff and maintenance staff. ICAO had already put into action a systemic approach to a possible outbreak of communicable disease. At the 35th Session of the ICAO Assembly, held in September/October 2004, ICAO Contracting States adopted Resolution A 35–12, which declared that the protection of the health of passengers and crews on international flights is an integral element of safe air travel and that conditions should be in place to ensure its preservation in a timely and cost effective manner. Through this Resolution, the ICAO Council was requested to review existing Standards and Recommended Practices (SARPs) of relevant Annexes to the Chicago Convention and adopt new SARPs as necessary, while maintaining institutional arrangements to coordinate efforts by Contracting States and other members of the international civil aviation community.

It is quite evident that both ICAO and IATA were concentrating on protecting the health of passengers and crew on the basis that the spread of a communicable disease within the aircraft should be avoided. Much had already been done regarding this area of concern in a technological context so much so that it was reasonably assumed that there was little possibility of the spread of a communicable disease through the ventilation system of an aircraft. It is a fact that there is nothing about an aircraft cabin that makes it easier to contract a communicable disease. In fact, quite the opposite appears to be true. The ventilation patterns on aircraft, combined with the circulation of air through High Efficiency Particulate Air (HEPA) filters reduces the spread of airborne pathogens, especially when compared with other public places

While all this is well and good, the question is whether, as was experienced during the outbreak of SARS in Toronto, where two Toronto residents brought SARS from Hong Kong to Toronto after travelling by air, the international community should be more concerned with the transmission of the disease across boundaries, which is the real danger and not merely within the aircraft itself.

The international health dimension of the Coronavirus involves human rights issues as well. International human rights law has laid down two critical aspects relating to public health: that protection of public health constitutes legitimate grounds for limiting human rights in certain circumstances (such as detention of persons or house arrest tantamount to quarantine exercises would be justified in order to contain a disease); and individuals have an inherent right to health. In this context it is not only the State or nation that has an obligation to notify WHO of communicable disease, but the human concerned as well, who has an abiding moral and legal obligation. In 1975, WHO issued a policy statement which subsumed its philosophy on health and human rights which stated that the individual is obliged to notify the health authorities when he is suffering from a communicable disease (including venereal diseases) or has been exposed to infection, and must undergo examination, treatment, surveillance, isolation or hospitalization. In particular, obligatory isolation or hospitalization in such cases constitutes a limitation on freedom of movement and the right to liberty and security of person.

When taken in context, the restrictions placed by the Chinese authorities in keeping the 35 million populaces in affected areas in 12 cities within their location (the population which exceeds those of California and New York) seems an effective and sensible measure to implement until the virus is contained. The SARS outbreak lasted approximately six months as the disease spread to more than two dozen countries in North America, South America, Europe, and Asia before it was stopped in July 2003. Let’s see what happens to its cousin in 2020.